Routine inspection·November 14, 2022

At approximately 9:15AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Required - 1 Year Visit Inspection and met with Administrator, Ricardo Tirado and Licensee Adam Waskow. Facility currently has 6 residents, and serves residents with dementia. Facility has a plan of operation for dementia care and programming. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival at the facility, LPA had their temperature checked and logged. LPA answered a standard COVID-symptom questionnaire and also had an antigen Covid-19 test conducted. Antigen testing is done prior to entrance for all visitors as a precaution. LPA conducted a walk-through of the facility and observed the following: COVID-19 signs were observed at the entry way and throughout the facility. Hand-washing signs were observed in the bathrooms and at sinks. All staff present were observed to be wearing a mask. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a cleaning and disinfecting schedule that occurs twice per day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for Residents. Staff and Residents are screened daily for COVID-19 symptoms. LPA and Administrator discussed the following: booster shots, activities, staffing, N95 fit testing, and training. Facility has a plan in place if a staffing shortage were to occur. Facility submitted their Mitigation/Infection Control Plan to Community Care Licensing (CCL). Fire extinguishers was last serviced September 2022. Facility has Nest Smoke and carbon monoxide detectors which were shown to be operational. The last facility fire and evacuation drill was conducted September 2022. Continued on LIC-809 C Continued from LIC-809 LPA requested the following documents to update facility file: Administrative Organization (LIC 309) Designation of Facility Responsibility (LIC 308) Emergency Disaster Plan (LIC 610D) Updated Personnel Report (LIC 500) Register of Clients/Residents (LIC 9020) Liability Insurance Documents to be submitted to CCL by due date of Friday, December 9, 2022. No Deficiencies Cited during visit. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.